B. A. GOODEN

Each year, drowning is responsible for an estimated 500,000 deaths around the world. The exact number is unknown because many drowning deaths go unreported.¹¹ This accident has been of major concern since the beginning of civilization.

The World Health Organization (WHO)⁵² has released statistics on the Global Burden of Injury (Table 1) that showed that drowning is the leading cause of death worldwide among females aged 5 to 14 years and is the fifth leading cause of death for females in the same age group. For both sexes combined, drowning was the fourth leading cause of death, exceeded only by acute lower respiratory infections, malaria, and injuries from motor vehicle accidents in the 5- to 14-year age group. Drowning as a cause of death ranked 11th for children aged 0 to 4 years and 10th for people aged 15 to 44 years. For both sexes, drowning as a cause of death in high-income countries in the Americas ranked sixth for children aged 0 to 4 years and fourth for children aged 5 to 14 years. For low- and middle-income countries in the Americas, drowning ranked as the 11th leading cause of death in children aged 0 to 4 years and second in children aged 5 to 14 years. According to WHO, in China, drowning is the leading cause of death for children aged 5 to 14 years for both sexes and ranks fourth for children aged 0 to 4 years and ninth for people aged 15 to 44 years.⁵²

In the United States, drowning is the third commonest cause of unintentional injury death for all ages and ranks second for people aged 5 to 44 years.^{[2] and [9]} Drowning is the second leading cause of accidental death in children aged 1 to 4 years in the United States and Africa (40 % of deaths)⁹ and the leading cause in this age group in Australia.²⁰ In 1995, the Brazilian population reached 155 million inhabitants, of whom 7020 (4.5/10,000 inhabitants) died because of drowning.⁴² Drowning is the third leading cause of accidental death for people of all ages in Brazil and second for children aged 1 to 14 years (Fig. 1).

Ironically, 90 % of all drowning deaths occur within 10 m of safety.¹¹ The patterns of drowning deaths are highly dependent on geographic factors. An estimated 40 % to 45 % of drowning deaths happen during swimming.⁸ In nautical sports, drowning is responsible for 90 % of deaths. Twelve to twenty-nine percent of drowning deaths are associated with boating accidents.⁸ In one study of patterns of drowning deaths in Australia from 1992 to 1997, Mackie²⁰ reported that the incidence of overall accidental, nonboating, drowning deaths was 1.44 per 100,000 population per year and that the incidence of drowning deaths occurring from boating accidents was 0.29 per 100,000 population per year. The commonest sites for nonboating drowning accidents were oceans or estuaries (22 % ), private swimming pools (17 % ), nontidal lakes and lagoons (17 % ), surfing beaches (10 % ), and bathtubs (7 % ). Approximately 22 % of victims were less than 5 years of age (4.6/100,000 population/year), and few of those drowned in the ocean or in boating accidents.

Freshwater drowning deaths are commoner among children than among adults and are especially common among children less than 10 years of age. In 1993, 4390 victims died in the United States,⁸ of whom 53 % drowned in swimming pools. In the United States, 50,000 new pools are built each year in addition to the 2.2 million residential pools and 2.3 million nonresidential pools already in existence. In the temperate areas of the United States, Australia, and South Africa, 70 % to 90 % of the deaths from drowning happen in residential pools.¹¹ In Brazil, where the number of residential pools is much smaller, freshwater drownings happen more commonly in rivers, lakes, and dams, contributing to half of the deaths by drowning.⁴⁶

In Brazil, the drowning death rate among people aged 20 to 29 years is without distinction among states with or without a coastline. Considering all ages, males die fivefold more often than do females. There is no sex distinction in death rates among children less than 1 year of age, but among people aged 20 to 29 years, men drown 8.7-fold more frequently than do women in this age group.⁴¹

In 1996, the United States Lifesaving Association reported 62,747 rescues on the shores of US beaches, with estimates of eight cases of near-drowning for each reported death.⁴⁶ On Rio de Janeiro beaches, data show approximately 290 rescues for each reported death (0.34 % ), and one death for each 10 victims admitted for medical care in the Drowning Recuperation Center (DRC) (10 % ).⁴⁷ In the past 31 years of work, the Rescue Service of Rio de Janeiro made approximately 166,000 rescues by lifeguards on the beaches, and 8500 victims needed medical attention in the DRC. Of all of those victims, 75 % were male, 83 % were unmarried, 46.6 % thought they knew how to swim, and 71.4 % resided far from the beach.⁴⁷ Most drownings occur in young, healthy, and productive people with life expectencies of many years.